| Vcphcs Xix, Llc | |
|
1869 Highway 45 Byp Suite 5 Jackson TN 38305-2464 | |
| (731) 660-0880 | |
| (731) 668-0380 |
| Full Name | Vcphcs Xix, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1869 Highway 45 Byp, Jackson, Tennessee |
| Authorized Official Name and Position | Jemece Michelle Gasaway (DIRECTOR OF LICENSING) |
| Authorized Official Contact | 2143656126 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vcphcs Xix, Llc 5001 Spring Valley Road Suite 600 East Dallas TX 75244-3946 Ph: (214) 365-6100 | Vcphcs Xix, Llc 1869 Highway 45 Byp Suite 5 Jackson TN 38305-2464 Ph: (731) 660-0880 |
| NPI Number | 1639515646 |
|---|---|
| Provider Enumeration Date | 05/16/2013 |
| Last Update Date | 02/20/2019 |
| Medicare PECOS PAC ID | 9537493739 |
|---|---|
| Medicare Enrollment ID | O20190621000955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639515646 | NPI | - | NPPES |
| Provider Name | Seth I Kaufman |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1891724738 PECOS PAC ID: 2769562644 Enrollment ID: I20080104000221 |
| Provider Name | Joann S Marrs |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1104855451 PECOS PAC ID: 9739401720 Enrollment ID: I20141202000930 |
| Provider Name | Nicky D Edwards |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1336531698 PECOS PAC ID: 0749500544 Enrollment ID: I20150519000959 |
| Provider Name | Molly Ledbetter |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184170268 PECOS PAC ID: 7810278710 Enrollment ID: I20170109002167 |
| Provider Name | Jose Luis Lopez-romero |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1659346674 PECOS PAC ID: 2466351762 Enrollment ID: I20170606002383 |
| Provider Name | Brian Edward Fuller |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1033409438 PECOS PAC ID: 1951616192 Enrollment ID: I20170725002414 |
| Provider Name | Rikki Lynn Pleasants |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1659326387 PECOS PAC ID: 1254344708 Enrollment ID: I20200402001070 |
| Provider Name | Ida Santana |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1942483003 PECOS PAC ID: 0941376529 Enrollment ID: I20200413000221 |
| Provider Name | Lisa Torres |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578105870 PECOS PAC ID: 3678995057 Enrollment ID: I20200613000050 |
| Provider Name | Parul V Patel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194347658 PECOS PAC ID: 6800210238 Enrollment ID: I20200720000153 |
| Provider Name | Jessica Brown |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033725775 PECOS PAC ID: 5496167769 Enrollment ID: I20201209003227 |
| Provider Name | Emily Hahn |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1811190796 PECOS PAC ID: 3375633589 Enrollment ID: I20210513002040 |
| Provider Name | Raza Hussain |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1891960431 PECOS PAC ID: 0941488217 Enrollment ID: I20210615000598 |
| Provider Name | John Francis O Connell |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1851479059 PECOS PAC ID: 1759717291 Enrollment ID: I20210812002823 |
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